MEDICARE: THERESA A BEASON LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	15498	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164766416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA A BEASON LPC

Provider Business Mailing Address
First Line	:	PO BOX 14261
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77221-4261
Country	:	US
Telephone Number	:	281-685-3447
Fax Number	:	713-741-4360

Provider Business Practice Location Address
First Line	:	5330 GRIGGS RD
Second Line	:	C-104
City	:	HOUSTON
State	:	TX
Zip	:	77021-3700
Country	:	US
Telephone Number	:	281-685-3447
Fax Number	:	713-741-4360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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Directions to “ THERESA A BEASON LPC” Practice Location

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